Retrospective cohort study of launching a new peroral pyloromyotomy practice-A framework for introducing endoscopic surgery within a hospital system.

Abstract

Endoscopic peroral pyloromyotomy for medically refractory gastroparesis requires advanced endoscopic skill. This study describes a learning framework using combined in-person and video-based proctoring. Retrospective data were collected for consecutive patients who underwent peroral pyloromyotomy by a single surgeon trained through a structured program: 4 case observations, 4 animal models, 9 in-person proctoring, and 8 video-based proctoring. Patient demographics, Gastroparesis Cardinal Symptom Index score, gastric emptying scintigraphy, and procedural details were collected. Data were analyzed using a 2-tailed, unpaired t test with unequal variance to compare the safety and effectiveness of video-based to the traditional, in-person proctoring. Short-term clinical outcomes, Gastroparesis Cardinal Symptom Index, and gastric emptying scintigraphy were measured. Peroral pyloromyotomy was performed on 17 patients (12 female; mean age, 53.8 years). Etiologies included diabetic (n = 6, 35.3%), idiopathic (n = 9, 52.9%), and postsurgical (n = 2, 11.8%). The median procedure time was 42.7 minutes (mean, 45.3 minutes; range, 29-65 minutes). Throughout both proctoring methods, the surgeon demonstrated safe, effective performance without complications or reintervention. There were no significant differences between in-person proctoring and video-based proctoring in total operative duration (P > .227). Patients exhibited expected clinical improvements with a Gastroparesis Cardinal Symptom Index score reduction of 2.38 units (70.6% reduction, P < .001). Through the integration of a novel learning framework, this study showed minimal time and outcome differences between in-person and video-based proctoring. Steps requiring cognitive training unique to endoscopic surgery (mucosotomy and tunneling) and standard myotomy had no statistical difference. This study supports an integrated in-person and video-proctoring framework as a safe and effective method to introduce advanced endoscopic surgery.